Seroprevalence of herpes simplex virus type 1 and type 2 among the migrant workers in Qatar

BACKGROUND

Limited data exists on herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infections in migrant populations. This study investigated HSV-1 and HSV-2 seroprevalences and associations among craft and manual workers (CMWs) in Qatar who constitute 60% of Qatar's population.

METHODS

A national population-based cross-sectional seroprevalence survey was conducted on the CMW population, all men, between July 26 and September 9, 2020. 2,612 sera were tested for anti-HSV-1 IgG antibodies using HerpeSelect 1 ELISA IgG kits and for anti-HSV-2 IgG antibodies using HerpeSelect 2 ELISA IgG kits (Focus Diagnostics, USA). Univariable and multivariable logistic regression analyses were conducted to identify associations with HSV-1 and HSV-2 infections.

RESULTS

Serological testing identified 2,171 sera as positive, 403 as negative, and 38 as equivocal for HSV-1 antibodies, and 300 sera as positive, 2,250 as negative, and 62 as equivocal for HSV-2 antibodies. HSV-1 and HSV-2 seroprevalences among CMWs were estimated at 84.2% (95% CI 82.8-85.6%) and 11.4% (95% CI 10.1-12.6%), respectively. HSV-1 infection was associated with nationality, educational attainment, and occupation. HSV-2 infection was associated with age, nationality, and educational attainment.

CONCLUSIONS

Over 80% of CMWs are infected with HSV-1 and over 10% are infected with HSV-2. The findings highlight the need for sexual health programs to tackle sexually transmitted infections among the CMW population.

Design and performance of a double-solenoid magnetic bottle photoelectron spectrometer for attosecond metrology

The design and performance of an in-house developed double-solenoid magnetic bottle (MB) time-of-flight photoelectron spectrograph are presented. A combination of a strong permanent magnet (Sm₂Co₁₇) with a soft iron cone and a double-solenoid geometry is used to generate MB configuration. The first solenoid (length ∼150 mm) is placed inside the vacuum, and the second solenoid (length ∼1 m) is placed outside the vacuum. The double-solenoid geometry improves the effective conductance and reduces overall material outgassing. Due to this, an ultra-high vacuum (∼5 × 10^-8 mbar) desirable for the working of the spectrograph was achieved using a small capacity (300 lps) turbo-molecular pump. An optimization of solenoid current generates a smooth magnetic field variation in MB, which keeps the adiabaticity parameter ∼0.6 at ∼25 eV photoelectron energy. The double-solenoid geometry also provides high collection efficiency as well as high energy resolution of the spectrograph. The experimentally measured energy resolution (ΔE) of the spectrograph is better than ∼60 meV at ∼15 eV photoelectron energy. The collection efficiency is estimated to be ∼25% under optimum conditions as compared with ∼10^-4 in field-free configuration. The calibrated MB spectrograph is used for the characterization of the attosecond pulse train using a cross-correlation "RABBITT" technique. The attosecond pulse train is generated from 15th to 25th odd high-harmonic orders, in argon filled cell. Attosecond pulses of average duration ∼260 as (FWHM) have been measured. The proposed MB electron spectrograph design provides a compact experimental setup for attosecond metrology and pump-probe studies with a relaxed requirement on vacuum pump capacity.

Deep learning model for predicting tunnel damages and track serviceability under seismic environment

Jammu and Kashmir in the northwestern part of the Himalayan region is frequently triggered with moderate to large magnitude earthquakes due to an active tectonic regime. In this study, a mathematical formulation-based Seismic Tunnel Damage Prediction (STDP) model is proposed using the deep learning (DL) approach. The pertinency of the DL model is validated using tunnel damage data from historical earthquakes such as the 1999 Chi-Chi earthquake, the 2004 Mid-Niigata earthquake, and the 2008 Wenchuan earthquake. Peak ground acceleration (PGA), source to site distance (SSD), overburden depth (OD), lining thickness (t), tunnel diameter (Ф), and geological strength index (GSI) were employed as inputs to train the Feedforward Neural Network (FNN) for damage state prediction. The performance evaluation results provided a clear indication for further use in a variety of risk assessment domains. When compared to models based on historical data, the proposed STDP model produces consistent results, demonstrating the robustness of the methodology used in this work. All models perform well during validation based on fitness metrics. The "STD multiple graphs" is also proposed which provide information on damage indexing, damage pattern, and crack predictive specifications. This can be used as a ready toolbox to check the vulnerability in post-seismic scenarios. The seismic design guidelines for tunnelling projects are also proposed, which discuss the damage pattern and suggest mitigation measures. The proposed STDP model, STD multiple graphs, and seismic design guidance are applicable to any earthquake-prone tunnelling project anywhere in the world.

Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

843 Improving Antibiotic Prophylaxis Prescribing in Arthroplasty Surgery Following Neck of Femur Fracture (NOF#): A Clinical Audit Revealing Multi-Factorial Influences on Prescribing Accuracy

Introduction

Post-op infection is a serious complication in surgery, particularly in arthroplasty. NICE guidelines advise antibiotic prophylaxis for all arthroplasty procedures to avoid this. This audit aimed to assess our concordance with our local guidelines and achieve improvements where we were deficient.

Method

Electronic prescribing records were analysed for 60 patients who underwent arthroplasty following NOF# across St. Richard's and Worthing Hospitals between 4/3/19 – 17/6/19. We presented these initial findings at our local orthopaedic clinical governance meeting to educate team members. We then collected a second cycle of data between 1/11/20 – 16/12/20.

Results

Patients receiving some form of antibiotic prophylaxis improved from 90% to 100%. Patients receiving the appropriate prophylaxis as per local guidelines increased from 78% to 83%. However, more patients were given incomplete prophylaxis in the second cycle: 5% of patients were on concurrent antibiotics for chest infection and were not given full prophylaxis, 5% of patients were under-dosed on gentamicin and 3% of patients were not given the full 24 hours’ worth of flucloxacillin. No patients developed joint infections post-op after following up for 6 months.

Conclusions

Although all patients were given prophylaxis in the second cycle, patients not receiving the full recommended course of antibiotics represents an avoidable risk in developing post-op infection. We identified that communication between orthopaedic surgeons, anaesthetists and orthogeriatric ward team members and awareness of prescribing responsibility were implicated in accurate prescribing of prophylactic antibiotics. We aim to address these with further education and amendments to performas and then re-audit to look for further improvements.

SARS-CoV-2 Infection Is at Herd Immunity in the Majority Segment of the Population of Qatar

BACKGROUND

Qatar experienced a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual worker (CMW) population, who comprise 60% of the total population. This study aimed to assess ever and/or current infection prevalence in this population.

METHODS

A cross-sectional population-based survey was conducted during July 26 to September 09, 2020, to assess both anti-SARS-CoV-2 positivity through serological testing and current infection positivity through polymerase chain reaction (PCR) testing. Associations with antibody and PCR positivity were identified through regression analyses.

RESULTS

The study included 2641 participants, 69.3% of whom were <40 years of age. Anti-SARS-CoV-2 positivity was 55.3% (95% CI, 53.3%-57.3%) and was significantly associated with nationality, geographic location, educational attainment, occupation, and previous infection diagnosis. PCR positivity was 11.3% (95% CI, 9.9%-12.8%) and was significantly associated with nationality, geographic location, occupation, contact with an infected person, and reporting 2 or more symptoms. Infection positivity (antibody and/or PCR positive) was 60.6% (95% CI, 58.6%-62.5%). The proportion of antibody-positive CMWs who had a prior SARS-CoV-2 diagnosis was 9.3% (95% CI, 7.9%-11.0%). Only seven infections were ever severe, and only 1 was ever critical-an infection severity rate of 0.5% (95% CI, 0.2%-1.0%).

CONCLUSIONS

Six in every 10 CMWs in Qatar have been infected, suggestive of reaching the herd immunity threshold. Infection severity was low, with only 1 in every 200 infections progressing to be severe or critical. Only 1 in every 10 infections had been previously diagnosed, which is suggestive of mostly asymptomatic or mild infections.

Estimation of External Contamination and Exposure Rates Due to Fission Product Release

In the event of a radiological incident, the release of fission products into the surrounding environment and the ensuing external contamination present a challenge for triage assessment by emergency response personnel. Reference exposure rate and skin dose rate calibration data for emergency response personnel are currently lacking for cases where receptors are externally contaminated with fission products. Simulations were conducted to compute reference exposure rate coefficients and skin dose rate coefficients from photon-emitting fission products of radiological concern. To accomplish this task, simplified mathematical skin phantoms were created using surface area and height specifications from International Commission on Radiological Protection Publication 89. Simulations were conducted using Monte Carlo radiation transport code using newborn, 1-y-old, 5-y-old, 10-y-old, 15-y-old, and adult phantoms for 22 photon-emitting radionuclides. Exposure rate coefficient data were employed in a case study simulating the radionuclide inventory for a 17 × 17 Westinghouse pressurized water reactor, following three burn-up cycles at 14,600 MWd per metric ton of uranium. The decay times following the final cycle represent the relative activity fractions over a period of 0.5-30 d. The resulting data can be used as calibration standards for triage efforts in emergency response protocols.

Extensive Spinal Epidural Abscess Associated with an Unremarkable Recovery

Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.

Cardiac Pathology in Patients with End-Stage Renal Disease Maintained on Hemodialysis

We report the spectrum of cardiovascular pathology found on autopsy examination in 106 consecutive patients with end-stage renal disease. Cardiovascular pathology was present in nearly all patients, and was the most frequent cause of death (36%), with acute myocardial infarction accounting for 15%. Particularly frequent pathologic findings were left ventricular hypertrophy, coronary and aortic atherosclerosis, pericarditis with effusion, myocardial fibrosis, and valvular dilatation. Cardiovascular death rate was higher during the first year than after the fifth year of dialysis. Nearly all patients had a history of hypertension. The nature of the underlying cause of renal failure and pre-existing cardiovascular disease, specifically diabetes mellitus and hypertension, were the principal predictors of cardiovascular mortality rather than maintenance hemodialysis therapy per se.

Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer

BACKGROUND

Malnutrition is frequent in lung cancer and is measured using various tools, including the novel bioelectric impedance technique for measuring body composition. However, the validation of this technique for assessing body composition in advanced small cell lung cancer (SCLC) is untested.

METHODS

Forty-one treatment naïve patients (all males) and an equal number of age- and sex-matched controls were evaluated by anthropometric measurements of skinfold thicknesses and body composition parameters such as body fat%, fat mass, fat-free mass (FFM), and total body water (TBW).

RESULTS

The mean (SD) age of the patient group was 55.7 (7.5) years, median pack-years was 20 (range, 0-80), and mean (SD) duration of symptoms was 152.6 (153.7) days. Median Karnofsky Performance Scale was 70 (range, 50-90). Majority of our patients (68.3%) were Stage IV followed by Stage III (31.7%). The percentage of patients with low, normal, and high body mass index (BMI) was 31.7%, 61%, and 7.3%, respectively. All components of body composition, i.e., body fat%, FFM, and TBW were significantly lower in patients compared to controls. However, the body composition in patients and controls with normal BMI was similar. The phenomenon of sarcopenia as a cause of cancer cachexia may explain these findings, whereas the combination of loss of body fat and lean body mass may lead to weight loss and reduced BMI.

CONCLUSION

Our results indicate that body composition is markedly altered in Indian patients with advanced SCLC. The impact of these parameters on clinically relevant outcomes needs further evaluation.

Diastereoselective synthesis of furanose and pyranose substituted glycine and alanine derivatives via proline-catalyzed asymmetric α-amination of aldehydes

A concise organocatalytic route toward the synthesis of furanose and pyranose substituted glycine and alanine derivatives is reported. These compounds are core structural units of some of the naturally available antibiotics and antifungal agents. Proline-catalyzed asymmetric α-amination of aldehydes derived from sugars is used as the key reaction to synthesize twelve sugar amino acid derivatives. The asymmetric transformations proceeded in good yields and with good to excellent diastereoselectivity. The application of the synthesized amino acids is demonstrated by synthesizing a tripeptide containing one of them.

Abstract P5-03-03: Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of cancer occurring in 15-20% of breast cancer patients, with most patients relapsing on currently approved therapy. Recent studies have shown activity of platinum chemotherapy in this class of patients. IO-125 is a novel platinum (II) chemotherapeutic agent with an unique coordination environment. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC.

The coordination environment in IO-125 facilitates supramolecular assembly and releases diaminocyclohexane (DACH)-platinum in a sustained pH-dependent manner. In vitro cell viability studies using an array of breast cancer cell lines shows IO-125 exerts increased potency compared to carboplatin or oxaliplatin. The maximum tolerated (platinum-equivalent) dose (MTD) of IO-125 in mice was 8-fold higher than the MTD (platinum-equivalent) dose of oxaliplatin. The biodistribution and pharmacokinetic profile of IO-125 in plasma and tumor revealed preferential tumor accumulation, significantly increased area-under-the-curve (AUC), a reduction in clearance (CL) and a longer terminal half-life (42 hours) in comparison to oxaliplatin (18 hours). In addition, DNA-Pt adduct formation in tumors was significantly higher for IO-125. When administered at their respective MTDs, IO-125 led to sustained regression of the tumor in a 4T1 syngeneic breast cancer model. Based on these observations, we conclude that IO-125 may emerge as a novel therapeutic against triple negative breast cancer.

Citation Format: Sengupta A, Roy M, Sarkar A, Mylavarapu S, Modi S, Gupta N, B H, Hossain S, Ansari A, Pandey M, Yadav Y, Sengupta S. Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-03.

Strategic aspects of higher education reform to cultivate specialists in diagnostic and biopharma industry as applicable to Predictive, Preventive and Personalized Medicine as the Medicine of the Future

Predictive, Preventive and Personalized Medicine as the Medicine of the Future represents an innovative model for advanced healthcare and robust platform for relevant industrial branches for diagnostics and pharmaceutics. However, rapid market penetration of new medicines and technologies demands the implementation of reforms not only in the spheres of biopharmaceutical industries and healthcare, but also in education. Therefore, the problem of the fundamental, modern preparation of specialists in bioengineering and affiliated fields is becoming particularly urgent, and it requires significant revision of training programs of higher education practice into current medical universities. Modernization and integration of widely accepted medical and teaching standards require consolidation of both the natural sciences and medical sciences that may become the conceptual basis for a university medical education. The main goal of this training is not simply to achieve advanced training and expansion of technological skills, but to provide development of novel multifaceted approaches to build academic schools for future generations.

A hybrid artificial neural network and particle swarm optimization for prediction of removal of hazardous dye brilliant green from aqueous solution using zinc sulfide nanoparticle loaded on activated carbon

In the present study, zinc sulfide nanoparticle loaded on activated carbon (ZnS-NP-AC) simply was synthesized in the presence of ultrasound and characterized using different techniques such as SEM and BET analysis. Then, this material was used for brilliant green (BG) removal. To dependency of BG removal percentage toward various parameters including pH, adsorbent dosage, initial dye concentration and contact time were examined and optimized. The mechanism and rate of adsorption was ascertained by analyzing experimental data at various time to conventional kinetic models such as pseudo-first-order and second order, Elovich and intra-particle diffusion models. Comparison according to general criterion such as relative error in adsorption capacity and correlation coefficient confirm the usability of pseudo-second-order kinetic model for explanation of data. The Langmuir models is efficiently can explained the behavior of adsorption system to give full information about interaction of BG with ZnS-NP-AC. A multiple linear regression (MLR) and a hybrid of artificial neural network and partial swarm optimization (ANN-PSO) model were used for prediction of brilliant green adsorption onto ZnS-NP-AC. Comparison of the results obtained using offered models confirm higher ability of ANN model compare to the MLR model for prediction of BG adsorption onto ZnS-NP-AC. Using the optimal ANN-PSO model the coefficient of determination (R(2)) were 0.9610 and 0.9506; mean squared error (MSE) values were 0.0020 and 0.0022 for the training and testing data set, respectively.

Comparison of nickel doped Zinc Sulfide and/or palladium nanoparticle loaded on activated carbon as efficient adsorbents for kinetic and equilibrium study of removal of Congo Red dye

In this study, the efficiency of nickel doped Zinc Sulfide nanoparticle loaded on activated carbon (Ni-ZnS-NP-AC) and palladium nanoparticles loaded on activated carbon (Pd-NP-AC) for the removal of Congo Red (CR) from aqueous solution was investigated. These materials were fully identified and characterized in term of structure, surface area and pore volume with different techniques such XRD, FE-SEM and TEM analysis. The dependency of CR removal percentage to variables such as pH, contact time, amount of adsorbents, CR concentration was examined and optimum values were set as: 0.03g Ni-ZnS-NP-AC and 0.04g of Pd-NP-AC at pH of 3 and 2 after mixing for 22 and 26min for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Subsequently, it was revealed that isotherm data efficiency can be correlated Langmuir with maximum monolayer adsorption capacities of 286 and 126.6mgg(-1) at room temperature for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Investigation of correlation between time and rate of adsorption reveal that the CR adsorption onto both adsorbents followed pseudo second order and interparticle diffusion simultaneously.

Bristol index of patellar width to thickness (BIPWiT): a reproducible measure of patellar thickness from adult MRI

BACKGROUND

The restoration of an adequate patellar thickness is a key to the successful outcome of knee arthroplasty. This study investigated the relationship between the thickness of the native patellar and medial-lateral patellar width using magnetic resonance imaging (MRI).

METHODS

75 MRI scans of young adults, with an average age of 27 (range 16-40) were studied. Exclusion criteria included a diagnosis of degenerative joint disease, patello-femoral pathology or age under 16/over 40 (170 patients). The bony thickness of the patellar, the chondral thickness and patellar width were measured, as was the location of maximal patellar thickness. Inter/intraobserver variability was calculated and correlation analysis was performed.

RESULTS

We found a strong correlation between patellar width and thickness (bone plus cartilage) (Pearson 0.75, P<0.001). The mean width to thickness ratio was 1.8:1 (standard deviation 0.1, 95% confidence interval 1.78-1.83). Without cartilage the ratio was 2.16:1 (SD 0.15, 95% CI 2.11-2.21), correlation was moderate (Pearson 0.59, P<0.001). The average maximal patellar cartilage thickness was 4.1mm (SD 1.3).

CONCLUSION

The strong correlation and narrow confidence intervals for the ratio of patellar width to thickness, suggest that patellar width might be used as a guide for accurate restoration of patellar thickness during total knee or patello-femoral replacement. After removing osteophytes we would recommend a ratio of 1.8:1. Further work is required to establish whether there is a relationship between anterior knee pain post total knee arthroplasty and an abnormal patellar width:thickness ratio.

LEVEL OF EVIDENCE

Level III.

Artificial neural network and particle swarm optimization for removal of methyl orange by gold nanoparticles loaded on activated carbon and Tamarisk

The influence of variables, namely initial dye concentration, adsorbent dosage (g), stirrer speed (rpm) and contact time (min) on the removal of methyl orange (MO) by gold nanoparticles loaded on activated carbon (Au-NP-AC) and Tamarisk were investigated using multiple linear regression (MLR) and artificial neural network (ANN) and the variables were optimized by partial swarm optimization (PSO). Comparison of the results achieved using proposed models, showed the ANN model was better than the MLR model for prediction of methyl orange removal using Au-NP-AC and Tamarisk. Using the optimal ANN model the coefficient of determination (R2) for the test data set were 0.958 and 0.989; mean squared error (MSE) values were 0.00082 and 0.0006 for Au-NP-AC and Tamarisk adsorbent, respectively. In this study a novel and green approach were reported for the synthesis of gold nanoparticle and activated carbon by Tamarisk. This material was characterized using different techniques such as SEM, TEM, XRD and BET. The usability of Au-NP-AC and activated carbon (AC) Tamarisk for the methyl orange from aqueous solutions was investigated. The effect of variables such as pH, initial dye concentration, adsorbent dosage (g) and contact time (min) on methyl orange removal were studied. Fitting the experimental equilibrium data to various isotherm models such as Langmuir, Freundlich, Tempkin and Dubinin-Radushkevich models show the suitability and applicability of the Langmuir model. Kinetic models such as pseudo-first order, pseudo-second order, Elovich and intraparticle diffusion models indicate that the second-order equation and intraparticle diffusion models control the kinetic of the adsorption process. The small amount of proposed Au-NP-AC and activated carbon (0.015 g and 0.75 g) is applicable for successful removal of methyl orange (>98%) in short time (20 min for Au-NP-AC and 45 min for Tamarisk-AC) with high adsorption capacity 161 mg g(-1) for Au-NP-AC and 3.84 mg g(-1) for Tamarisk-AC.

Autologous stem cell transplantation in severe treatment-resistant Crohn's disease: long-term follow-up of UK patients treated on compassionate basis

BACKGROUND

Although autologous stem cell transplantation (ASCT) may achieve disease control in severe treatment-resistant Crohn's disease (CD), relapse is frequent, and there is little information regarding long-term outcomes in terms of response to subsequent treatments and complications of ASCT.

DESIGN

Retrospective evaluation of UK patients treated on a compassionate basis from three UK tertiary centres.

METHODS

We summarize long-term outcomes of six previously unreported patients with severe treatment-resistant CD treated with ASCT according to international guidelines between 2003 and 2009. Median duration of CD before ASCT was 14 (7-22) years. Following stem cell mobilization, patients were treated with high-dose cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulin (7.5 mg/kg) followed by ASCT.

RESULTS

All patients tolerated ASCT with routine toxicities and no treatment-related mortality and are alive at 50-123 months post-ASCT. Clinical and endoscopic remissions of CD were confirmed at 3 months post-ASCT in five patients, although median time to next treatment for inflammatory disease was 10 months (range: 3-16 months). Subsequently, disease control was achieved with previously ineffective and newer treatments, with surgery performed predominantly for pre-existing fibrotic strictures. Two patients became independent of home total parenteral nutrition (TPN). Reported late complications of ASCT included hypothyroidism and ovarian failure.

CONCLUSION

Long-term follow-up supports the safety and feasibility of ASCT as a means of achieving short-term control of severe CD whilst potentially re-sensitizing the disease to medical therapy and reducing requirements for surgery and TPN. Given the inevitability of relapse, pre-emptive salvage and/or maintenance treatments post-ASCT should be the focus of future trials.

Comparison of nickel oxide and palladium nanoparticle loaded on activated carbon for efficient removal of methylene blue

Palladium nanoparticles (Pd-NPs) and nickel oxide nanoparticles (NiO-NPs) were synthesized and loaded on activated carbon (AC). This novel material successfully used for the removal of methylene blue (MB) dye from aqueous medium. Full characterization of both material using X-ray diffraction, transmission electron microscopy, scanning electron microscopy and Brunauer–Emmet–Teller analyses for Pd-NP show their high surface area (>1340 m2/g) and low pore size (<20 Å) and average particle size lower than 45 Å and for NiO-NP show their high surface area (>1316.1554 m2/g) and low pore size (<20 Å) and average particle size lower than 46 Å in addition to high reactive atom and presence of various functional groups. These unique properties make them possible for efficient removal of MB. In batch experimental set-up, optimum conditions for maximum removal of MB by both adsorbents were attained following searching effect of variables such as central composite design. The Langmuir isotherm was found to be highly recommended for fitting the experimental equilibrium data. The kinetic of adsorption of MB on both adsorbents strongly can be fitted by a combination of pseudo-second order and intraparticle diffusion pathway. The experimental result achieved in this article shows the superiority of Pd-NP-AC for MB removal than NiO-NP-AC, so the maximum adsorption capacities of Pd-NP-AC and NiO-NP-AC were 555.5 mg/g and 588.2 mg/g, respectively.

Comparison of the efficiency of Cu and silver nanoparticle loaded on supports for the removal of Eosin Y from aqueous solution: Kinetic and isotherm study

In this study, the efficiency of a novel copper containing ionic liquid based nanoporous organosilica (Cu@IL-ONO) and palladium nanoparticles loaded on activated carbon (Pd-NP-AC) for the removal of Eosin Y from aqueous solution was investigated. The Cu@IL-ONO was prepared by hydrolysis and co-condensation of tetramethoxysilane (TMOS) and 1,3-bis (trimethoxysilylpropyl) imidazolium chloride in the presence of surfactant template following immobilization of copper chloride dihydrate. These materials were characterized by nitrogen adsorption-desorption analysis and scanning electron microscopy (SEM) and subsequently used for the successful removal of Eosin Yellow (EY) from aqueous solution. The effects of pH, contact time, amount of adsorbents, initial dye concentration was optimized and set as following: 0.005g/50mL Cu@IL-ONO and 0.015g/50mL Ag-NP-AC at pH=2 for Cu@IL-ONO and pH=3 for Ag-NP-AC and contact time less than 14min. The experimental removal percentage data at various situations was fitted by conventional isotherm models like Langmuir, Freundlich, Tempkin and Dubinin-Radushkevich (D-R). Judgment based on linear regression coefficient (R(2)) and error analysis show high usability of the Langmuir isotherm for best explanation of experimental data with maximum monolayer adsorption capacities 286 and 250mgg(-1) at room temperatures for Cu@IL-ONO and Ag-NP-AC, respectively. Fitting the corresponding data of removal percentage at various experimental conditions shows the suitability of second order and interparticle diffusion model for interpretation of real data.

Microsurgical excision of olfactory groove meningioma's: a brief study of outcome of different surgical approaches

DOI: http://dx.doi.org/10.3329/bmrcb.v39i1.15810Bangladesh Med Res Counc Bull 2013; 39: 45-46

Assessing internal contamination after the detonation of a radiological dispersion device using a 2x2-inch sodium iodide detector

The detonation of a radiological dispersion device may result in a situation where individuals inhale radioactive materials and require rapid assessment of internal contamination. The feasibility of using a 2×2-inch sodium-iodide detector to determine the committed effective dose to an individual following acute inhalation of gamma-emitting radionuclides was investigated. Experimental configurations of point sources with a polymethyl methacrylate slab phantom were used to validate Monte Carlo simulations. The validated detector model was used to simulate the responses for four detector positions on six different anthropomorphic phantoms. The nuclides examined included (241)Am, (60)Co, (137)Cs, (131)I and (192)Ir. Biokinetic modelling was employed to determine the distributed activity in the body as a function of post-inhalation time. The simulation and biokinetic data were used to determine time-dependent count-rate values at optimal detector locations on the body for each radionuclide corresponding to a target committed effective dose (E50) value of 250 mSv.

Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series

We report a prospective analysis of clinical outcome in patients treated with medial patellofemoral ligament (MPFL) reconstruction using an autologous semitendinosus graft. The technique includes superolateral portal arthroscopic assessment before and after graft placement to ensure correct graft tension and patellar tracking before fixation. Between October 2005 and October 2010, a total of 201 consecutive patients underwent 219 procedures. Follow-up is presented for 211 procedures in 193 patients with a mean age of 26 years (16 to 49), and mean follow-up of 16 months (6 to 42). Indications were atraumatic recurrent patellar dislocation in 141 patients, traumatic recurrent dislocation in 50, pain with subluxation in 14 and a single dislocation with persistent instability in six. There have been no recurrent dislocations/subluxations. There was a statistically significant improvement between available pre- and post-operative outcome scores for 193 patients (all p < 0.001). Female patients with a history of atraumatic recurrent dislocation and all patients with history of previous surgery had a significantly worse outcome (all p < 0.05). The indication for surgery, degree of dysplasia, associated patella alta, time from primary dislocation to surgery and evidence of associated cartilage damage at operation did not result in any significant difference in outcome. This series adds considerably to existing evidence that MPFL reconstruction is an effective surgical procedure for selected patients with patellofemoral instability.

Evaluation of internal contamination levels after a radiological dispersal device incident using portal monitors

Following a radioactive dispersal device (RDD) incident, it may be necessary to evaluate the internal contamination levels of a large number of potentially affected individuals to determine if immediate medical follow-up is necessary. Since the current laboratory capacity to screen for internal contamination is limited, rapid field screening methods can be useful in prioritising individuals. This study evaluated the suitability of a radiation portal monitor for such screening. A model of the portal monitor was created for use with models of six anthropomorphic phantoms in Monte Carlo N-Particle Transport Code Version 5 (MCNP) X-5 Monte Carlo Team (MCNP-A General Monte Carlo N-Particle Transport Code Version 5. LA-CP-03-0245. Vol. 2. Los Alamos National Laboratory, 2004.). The count rates of the portal monitor were simulated for inhalation and ingestion of likely radionuclides from an RDD for each of the phantoms. The time-dependant organ concentrations of the radionuclides were determined using Dose and Risk Calculation Software Eckerman, Leggett, Cristy, Nelson, Ryman, Sjoreen and Ward (Dose and Risk Calculation Software Ver. 8.4. ORNL/TM-2001/190. Oak Ridge National Laboratory, 2006.). Portal monitor count rates corresponding to a committed effective dose E(50) of 10 mSv are reported.

Using handheld plastic scintillator detectors to triage individuals exposed to a radiological dispersal device

After a radiological dispersal device (RDD) event, people could become internally contaminated by inhaling dispersed radioactive particles. A rapid method to screen individuals who are internally contaminated is desirable. Such initial screening can help in prompt identification of those who are highly contaminated and in prioritising individuals for further and more definitive evaluation such as laboratory testing. The use of handheld plastic scintillators to rapidly screen those exposed to an RDD with gamma-emitting radionuclides was investigated in this study. The Monte Carlo N-Particle transport code was used to model two commercially available plastic scintillation detectors in conjunction with anthropomorphic phantom models to determine the detector response to inhaled radionuclides. Biokinetic models were used to simulate an inhaled radionuclide and its progression through the anthropomorphic phantoms up to 30 d after intake. The objective of the study was to see if internal contamination levels equivalent to 250 mSv committed effective dose equivalent could be detected using these instruments. Five radionuclides were examined: (60)Co, (137)Cs, (192)Ir, (131)I and (241)Am. The results demonstrate that all of the radionuclides except (241)Am could be detected when placing either one of the two plastic scintillator detector systems on the posterior right torso of the contaminated individuals.

Low-dose azathioprine or mercaptopurine in combination with allopurinol can bypass many adverse drug reactions in patients with inflammatory bowel disease

BACKGROUND

The thiopurine drugs, azathioprine and mercaptopurine (MP), are established treatments for IBD. However, therapeutic failure caused by adverse drug reactions occurs frequently.

AIM

To study combination of allopurinol with reduced-dose thiopurine in an attempt to avoid adverse drug reactions in the treatment of IBD.

METHODS

Patients with drug reactions to full-dose thiopurines were recruited for combination therapy in two IBD centres in this retrospective study. Dosing was guided by measuring thiopurine methyltransferase (for UK patients) or thioguanine nucleotides and methyl-6MP (Australian patients). Response was monitored by clinical activity indices.

RESULTS

Of 41 patients, 25 had non-hepatic and 16 had hepatitic reactions. Clinical remission was achieved in 32 patients (78%) with a median follow-up of 41 weeks (range 0.5-400). Patients who did not respond to combination therapy tended to fail early with the same adverse reaction. The relative risk of having an adverse reaction with methyl-6MP in the top interquartile range was 2.7 (1.3-28) times that with methyl-6MP in the lower three quartiles (95% confidence interval).

CONCLUSION

The combined experience from our centres is the largest reported experience of this combination therapy strategy in IBD, and the first to provide evidence for benefit in thiopurine and allopurinol co-therapy to avoid non-hepatitic adverse drug reactions.

Novel pharmacogenetic markers for treatment outcome in azathioprine-treated inflammatory bowel disease

BACKGROUND

Azathioprine (AZA) pharmacogenetics are complex and much studied. Genetic polymorphism in TPMT is known to influence treatment outcome. Xanthine oxidase/dehydrogenase (XDH) and aldehyde oxidase (AO) compete with TPMT to inactivate AZA.

AIM

To assess whether genetic polymorphism in AOX1, XDH and MOCOS (the product of which activates the essential cofactor for AO and XDH) is associated with AZA treatment outcome in IBD.

METHODS

Real-time PCR was conducted for a panel of single nucleotide polymorphism (SNPs) in AOX1, XDH and MOCOS using TaqMan SNP genotyping assays in a prospective cohort of 192 patients receiving AZA for IBD.

RESULTS

Single nucleotide polymorphism AOX1 c.3404A > G (Asn1135Ser, rs55754655) predicted lack of AZA response (P = 0.035, OR 2.54, 95%CI 1.06-6.13) and when combined with TPMT activity, this information allowed stratification of a patient's chance of AZA response, ranging from 86% in patients where both markers were favourable to 33% where they were unfavourable (P < 0.0001). We also demonstrated a weak protective effect against adverse drug reactions (ADRs) from SNPs XDH c.837C > T (P = 0.048, OR 0.23, 95% CI 0.05-1.05) and MOCOS c.2107A > C, (P = 0.058 in recessive model, OR 0.64, 95%CI 0.36-1.15), which was stronger where they coincided (P = 0.019).

CONCLUSION

These findings have important implications for clinical practice and our understanding of AZA metabolism.